Inflammation and endothelial dysfunction are associated with retinopathy: the Hoorn Study
Inflammation and endothelial dysfunction are associated with retinopathy: the Hoorn Study
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DOI：
10.1007/s00125-005-1799-y
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发表时间：
2005-07-01
期刊：
影响因子：
8.2
通讯作者：
Stehouwer, CDA
中科院分区：
文献类型：
--
作者：
van Hecke, MV;Dekker, JM;Stehouwer, CDA
目的/假设：糖尿病和非糖尿病患者视网膜病变的确切发病机制尚不完全清楚，但可能涉及慢性低度炎症和血管内皮功能障碍。这项研究的目的是调查炎症和内皮功能障碍与2型糖尿病患者和非2型糖尿病患者常见视网膜病变的关系。方法：作为一项基于人群的队列研究的一部分，625名年龄在50-74岁之间的个体，根据年龄、性别和糖耐量状况进行分层，接受了广泛的体检。视网膜病变通过眼科检查来评估，包括眼底镜和双眼散瞳的双视野45度眼底照相。测定C-反应蛋白(CRP)、可溶性细胞间黏附分子-1(sICAM-1)、血管性血友病因子(Von Willebrand)和可溶性血管黏附分子-1(sVCAM-1)水平，以及尿白蛋白/肌酐比值，并结合结果得出炎症和内皮功能障碍的综合z评分。结果：视网膜病变的发生率与CRP、sICAM-1呈正相关。在所有受试者中，与最低的三分位数相比，炎症z分数最高的三分位数与视网膜病变有关(优势比[OR]=2.2，95%可信区间1.2-4.1，调整了年龄、性别和糖耐量状态)。在糖尿病患者中，内皮功能障碍的最高三分率与视网膜病变有关(OR=4.4，95%可信区间1.2-15.9，调整了年龄和性别后)，但在非糖尿病患者中不相关。对其他危险因素的额外调整，如收缩压和舒张压、体重指数、总胆固醇和甘油三酯，或者炎症和内皮功能障碍z评分的相互调整，都不会改变结果。结论/解释：在这项研究中，炎症活动和内皮功能障碍与视网膜病变有关，这表明它们参与了视网膜病变的发病机制。
Aims/hypothesis: The exact pathogenesis of retinopathy in diabetic and non-diabetic individuals is incompletely understood, but may involve chronic low-grade inflammation and dysfunction of the vascular endothelium. The aim of this study was to investigate the association of inflammation and endothelial dysfunction with prevalent retinopathy in individuals with and without type 2 diabetes. Methods: As part of a population-based cohort study, 625 individuals aged 50-74 years, stratified according to age, sex and glucose tolerance status, underwent an extensive physical examination. Retinopathy was assessed by an ophthalmological examination, including funduscopy and two-field 45 degrees fundus photography with mydriasis in both eyes. Levels of C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1), von Willebrand factor, and soluble vascular adhesion molecule-1 (sVCAM-1) were assessed, together with the urinary albumin : creatinine ratio, and the results were combined to obtain summarising z scores for inflammation and endothelial dysfunction. Results: The prevalence of retinopathy was positively associated with tertiles of CRP and sICAM-1. When compared with the lowest tertile, the highest tertile of the inflammatory z score was associated with retinopathy in all subjects (odds ratio [OR]=2.2, 95% CI 1.2-4.1, adjusted for age, sex and glucose tolerance status). The highest tertile of the endothelial dysfunction z score was associated with retinopathy among diabetic individuals (OR=4.4, 95% CI 1.2-15.9, adjusted for age and sex) but not in non-diabetic individuals. Additional adjustment for other risk factors, such as systolic and diastolic blood pressure, BMI, total cholesterol and triglycerides, or mutual adjustment of the inflammatory and endothelial dysfunction z scores did not change the results. Conclusions/interpretation: In this study, inflammatory activity and endothelial dysfunction were associated with retinopathy, which suggests their involvement in the pathogenesis of retinopathy.